DHGNA Transplante de Fígado

Transcrição

1 DHGNA Transplante de Fígado EDISON ROBERTO PARISE Disciplina de Gastroenterologia Grupo de Fígado Universidade Federal de São Paulo UNIFESP

2 Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States from 1988 to Younossi ZM,et al. Clin Gastroenterol Hepatol Prevalência Hepatopatia cronica % 15.66% 14.78% Hepatite B 0.36% 0.33% 0.34% Hepatite C 1.95% 1.97% 1.68% Álcool 1.38% 2.21% 2.05% DHGNA 5.51% 9.84% 11.01% Serologic and clinical data were used to establish the diagnoses of CLDs in 39,500 adults.

3 NASH -3ª CAUSA DE TX HEPÁTICO NOS EUA E A ÚNICA EM CRESCIMENTO Charlton, Gastroenterology 2011

4 Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Wong RJ, Aguilar M, Cheung R et al. Gastroenterology 2015 Mar % % 45% NASH HCV ALD Colunas1

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6 Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S. % Transplanted Patients Wong RJ, Cheung R, Ahmed A. Hepatology NASH HCV

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14 RECORRÊNCIA DA ESTEATO-HEPATITE NÃO ALCOÓLICA PÓS TRANSPLANTE HEPÁTICO De 622 OLTx, 8 com EHNA Após 15 meses seguimento 6 com esteatose, 3 com NASH ( 2 c/fibrose) 2 sem recorrência Correlação com IMC EVOLUÇÃO IMC PÓS-TX (Ray Kim et al,transplantation, 1996) sem 4m 1a 2a 4a --- EHNA --- sem recorrência

15 Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis and Orthotopic Liver Transplantation Anne Burkea and Michael R. Luceyb, Am J Transplant 2004 Risk factor Prevalence Post- Transplant Rate in US Population Hypertension (BP > 140/90) 41 81% 15.7% Hypercholesterolemia (240 mg%) 20 66% 14.9% Diabetes mellitus 21 32% 6.2% Obesity (BMI > 30) 39 43% 16.1% HDL < 35 mg% HDL 52% 12%

16 Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis and Orthotopic Liver Transplantation Anne Burkea and Michael R. Luceyb, Am J Transplant 2004 Risk factor Prevalence Post- Transplant Rate in US Population Hypertension (BP > 140/90) 41 81% 15.7% Hypercholesterolemia (240 mg%) 20 66% 14.9% Diabetes mellitus 21 32% 6.2% Obesity (BMI > 30) 39 43% 16.1% HDL < 35 mg% HDL 52% 12%

17 Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis and Orthotopic Liver Transplantation Anne Burkea and Michael R. Luceyb, Am J Transplant 2004 Risk factor Prevalence Post- Transplant Rate in US Population Hypertension (BP > 140/90) 41 81% 15.7% Hypercholesterolemia (240 mg%) 20 66% 14.9% Diabetes mellitus 21 32% 6.2% Obesity (BMI > 30) 39 43% 16.1% HDL < 35 mg% HDL 52% 12%

18 40.00% PREVALENCIA DE DHGNA NO PÓS-TRANSPLANTE HEPÁTICO DE ACORDO COM ETIOLOGIA DA DOENÇA Prevalencia de DHGNA 30.00% 20.00% 10.00% 0.00% 1 ANO 2 ANOS 5 ANOS 10 ANOS Yalamanchili K, Saadeh S, Klintmalm GB, Jennings LW, Davis GL. Nonalcoholic fatty liver disease after liver transplantation for cryptogenic cirrhosis or nonalcoholic fatty liver disease. Liver Transpl 2010; 16:

19 Combined Liver Transplantation and Gastric Sleeve Resection for Patients With Medically Complicated Obesity and End-Stage Liver Disease Heimbacha JK et al. Am J Transplantation 2013 Table 1: Characteristics of 37 patients enrolled in the noninvasive weight loss protocol, compared to those who underwent combined liver transplant plus sleeve gastrectomy.; BMI=body mass index Characteristic Total n=37 Total N=7 p-value Gender M:F 16:21 4: diagnosis NASH=12 HCV+HCC=9HCC +other=3 CCA=3 All NASH=5 HCV/NASH =1 Alpha-1/NASH=1 Age at transplant 50 (range (range ) 60) MELD at 19 (range 8 35) 32 (range 11 <0.001 transplant 40) Postoperative 2/37 (5%) deaths N with BMI> 35 21/35 (60%) 0/ posttransplant Diabetes posttransplant 12/35 0/7 0.03

20 Conclusões 1-NASH é a etiologia que mais cresce entre pacientes submetidos a transplante de fígado em consequência a doença hepática crônica e carcinoma hepatocelular 2- A sobrevida desses pacientes é semelhante a observada para pacientes com outras doenças hepatocelulares. 3- Entretanto, esses pacientes estão mais sujeitos a apresentar complicações como cardiovasculares e sepsis no póstransplante. 4- As comorbidades prévias e aquelas decorrentes do transplante determinam recorrência da doença e aparecimento de novo da doença em significativo número de pacientes ( 20% a 40% dos pacientes transplantados por NASH e outras causas).